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Lung transplantation

What's new

Added 2024 ERS/EBMT, 2021 ISHLT, 2020 BTS, and 2019 AST guidelines on lung transplantation.

Guidelines

Key sources

The following summarized guidelines for the management of lung transplantation are prepared by our editorial team based on guidelines from the European Respiratory Society (ERS/EBMT 2024), the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2024), the American College of Rheumatology (ACR 2023), the European Society of Cardiology (ESC/ERS 2022), the Histiocyte Society (HS 2022), the Consensus Expert Panel for...
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Perioperative care

Antifungal prophylaxis: as per AST 2019 guidelines, Consider administering either universal prophylaxis or preemptive therapy as a strategy to prevent invasive aspergillosis in lung transplant recipients, depending on the availability of the diagnostic tests.
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  • Influenza prophylaxis

Surgical interventions

General principles: as per ISHLT 2021 guidelines, Consider offering lung transplantation in adult patients with chronic, end-stage lung disease meeting all the following general criteria:
high (> 50%) risk of death from lung disease within 2 years if lung transplantation is not performed
high (> 80%) likelihood of 5-year post-transplant survival from a general medical perspective provided there is adequate graft function.
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  • Indications in COPD

  • Indications in AAT deficiency

  • Indications in idiopathic pulmonary fibrosis

  • Indications in ILD

  • Indications in cystic fibrosis

  • Indications in bronchiectasis

  • Indications in pulmonary arterial hypertension

  • Indications in chronic thromboembolic pulmonary hypertension

  • Indications in pulmonary AVMs

  • Indications in pulmonary sarcoidosis

  • Indications in pulmonary lymphangioleiomyomatosis

  • Indications in Langerhans cell histiocytosis

  • Indications in NTM pulmonary disease

  • Indications in ARDS

  • Indications in lung cancer

  • Considerations for multiorgan transplantation

  • Considerations for re-transplantation

Follow-up and surveillance

Management of bronchiolitis obliterans syndrome, primary prevention: as per BTS 2020 guidelines, Consider initiating low-dose, long-term azithromycin (250 mg thrice weekly) to prevent bronchiolitis obliterans syndrome after lung transplantation.
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  • Management of bronchiolitis obliterans syndrome (tacrolimus)

  • Management of bronchiolitis obliterans syndrome (azithromycin)

  • Management of bronchiolitis obliterans syndrome (corticosteroids)

  • Management of bronchiolitis obliterans syndrome (fundoplication)

  • Management of bronchiolitis obliterans syndrome (re-transplantation)